Doctors group looking at intensive course to train willing MDs in assisted death

Doctors who are willing to assist in a patient’s death once the act becomes legal early next year will need to be trained because they’ve never been taught the procedures for ending a life, the Canadian Medical Association says.

“There’s a lot of complexity in this for Canadian doctors and it’s the first time really any of us can remember that (we) have been forced to undertake an entirely new procedure or new intervention without any training or experience,” Dr. Jeff Blackmer, vice-president of medical professionalism, told a media briefing Tuesday during the CMA’s annual meeting in Halifax.

Blackmer said the 80,000-member doctors’ organization is considering an intensive two-day course for physicians “who have never had to learn this, who have not taken it in medical school or residency.”

Physicians who choose not to participate in assisted death may be offered an online course so they can counsel patients who want to pursue help in dying. Those who are willing to provide the service would continue to take courses over the years, he said.

“We want to make sure people are trained and have the competencies to do this,” Blackmer said.

On Feb. 6 of this year, the Supreme Court of Canada struck down the law banning doctors from assisting a patient to die or from performing euthanasia. The court stayed its decision for a year to give the federal government time to draft and pass replacement legislation.

If no such law is passed, doctors can legally begin helping patients who meet certain criteria to end their lives.

Outgoing CMA president Dr. Chris Simpson said time is growing short for regulators to determine how the service would be provided and how doctors would decide whether a given patient is eligible for assisted death under the Supreme Court’s ruling.

“We don’t want to arrive at Feb. 6 with everybody saying, ‘Well, assisted dying in Canada is legal. Does anybody know how to do it? Does anybody know who qualifies?’” Simpson said.

“That is a situation I think we all agree cannot happen.”

Simpson said the CMA is lobbying for replacement legislation with national standards, rather than a patchwork of provincial and territorial regulations that wouldn’t serve patients across the country equally.

“At the end of the day, regardless of who wins the election, the law that banned assisted suicide is no longer in effect as of February and so governments are going to have to deal with this,” he said.

“The question is whether or not we’re going to deal with it in a rational and professional way that serves the needs of Canadians or whether we’re just going to leave it to chance.”

The CMA recently invited its members to participate in an online survey about assisted death. Of 1,407 members who responded, 29 per cent said they would consider providing the service, 63 per cent said they would not, and eight per cent said they weren’t sure, the CMA reported.

Delegates discussing the issue during a session at the Halifax meeting on Tuesday expressed a number of concerns, including whether doctors against the practice on moral or religious grounds would be required to refer a patient to a willing physician.

In the end, they favoured a recommendation to provide patients with information about the option, including how to access the service, Blackmer said.

“My concern remains more in the rural and remote communities, where there may only be one or two GPs, and if they are both unwilling to participate, I think that’s when we’re going to have to look at what some solutions are,” he said, noting that the Netherlands has a mobile clinic that goes from community to community to provide assisted dying.

“The geography of Canada obviously is somewhat limiting in that respect, but we plan to examine some of those models and see what may apply here in Canada.”